Bottom Line:
Only one patient had recurrence after surgery, and another had lung metastasis when diagnosed with BcaFad.Adjuvant radiotherapy could be performed, but was not mandatory.Chemotherapy should be considered as a treatment option in the presence of lymph node metastasis.

Background: Breast cancer arising within a fibroadenoma (BcaFad) is rare; the rate varies from 0.002% to 0.125% in fibroadenoma specimens. Owing to its rarity, the clinicopathologic feature and treatment principle of BcaFad is still not clear. Therefore, the aim of this study was to perform a collective analysis of case reports in the literature to identify the characteristics and optimal treatment for BcaFad.

Methods: We analyzed an aggregated sample of 30 patients with BcaFad from case reports in the literature (n=24 cases) and our present study (n=6 cases). We collected and analyzed the clinicopathologic features and prognoses of patients with BcaFad, as well as treatments they received.

Results: The patients' mean age at diagnosis was 46.9 years. Twenty BcaFad patients (66.7%) received breast-conserving surgery (BCS), and nine other patients (30.0%) were treated with mastectomy. The rate of lymph node metastasis in BcaFad patients was 23.8%. The breakdown of the histological types of BcaFad was invasive ductal carcinoma (53.3%), followed by ductal carcinoma in situ (23.3%), lobular carcinoma in situ (16.7%) and invasive lobular carcinoma (13.3%). More than half of patients with positive hormone receptor status received hormone therapy. Most BcaFad patients with lymph node metastases received chemotherapy, and 20.0% of BcaFad patients treated with BCS received further radiotherapy. Only one patient had recurrence after surgery, and another had lung metastasis when diagnosed with BcaFad.

Conclusions: Most BcaFad patients could be managed by BCS. Adjuvant radiotherapy could be performed, but was not mandatory. Chemotherapy should be considered as a treatment option in the presence of lymph node metastasis.

Fig1: Flowchart of the search strategy. We initially identified 861 articles in the databases searched according to the keywords used. We excluded 801 articles after title screening because they did not mention fibroadenoma-related carcinoma, leaving 60 articles retrieved that described a significant relationship between fibroadenoma and carcinoma. We excluded 22 articles for lack of case details, even in the abstracts; 5 articles for no case data in the main text; 3 articles for focusing on other rare cancers linked to fibroadenoma; and 9 articles because they were case analyses or reviews. Thus, 24 cases from 21 studies were included, together with our 6 cases, which gave us a total of 30 cases for the final analysis.

Mentions:
In our literature review, we collected 24 cases with detailed information from 21 English-language articles. After combining these with our 6 cases, the study population comprised 30 BcaFad patients (Figure 1 and Table 1). All of the patients were female, and their mean age at diagnosis was 46.9 years old (range, 27 to 80 years old). The mean duration from the finding of fibroadenoma to surgical excision was 61.2 months (range, 0.5 to 600 months). The mean tumor size of the fibroadenoma was 2.46 cm (range, 0.8 to 5.1 cm). Most of the cancers found inside the breast fibroadenoma were in situ carcinoma or early breast cancer with minimal or small tumor size. The distribution of tumor locations was the right side (53.3%), followed by the left side (40.0%) and bilateral breast (3.3%). The clinicopathologic data of these 30 patients are summarized in Table 1.Figure 1

Fig1: Flowchart of the search strategy. We initially identified 861 articles in the databases searched according to the keywords used. We excluded 801 articles after title screening because they did not mention fibroadenoma-related carcinoma, leaving 60 articles retrieved that described a significant relationship between fibroadenoma and carcinoma. We excluded 22 articles for lack of case details, even in the abstracts; 5 articles for no case data in the main text; 3 articles for focusing on other rare cancers linked to fibroadenoma; and 9 articles because they were case analyses or reviews. Thus, 24 cases from 21 studies were included, together with our 6 cases, which gave us a total of 30 cases for the final analysis.

Mentions:
In our literature review, we collected 24 cases with detailed information from 21 English-language articles. After combining these with our 6 cases, the study population comprised 30 BcaFad patients (Figure 1 and Table 1). All of the patients were female, and their mean age at diagnosis was 46.9 years old (range, 27 to 80 years old). The mean duration from the finding of fibroadenoma to surgical excision was 61.2 months (range, 0.5 to 600 months). The mean tumor size of the fibroadenoma was 2.46 cm (range, 0.8 to 5.1 cm). Most of the cancers found inside the breast fibroadenoma were in situ carcinoma or early breast cancer with minimal or small tumor size. The distribution of tumor locations was the right side (53.3%), followed by the left side (40.0%) and bilateral breast (3.3%). The clinicopathologic data of these 30 patients are summarized in Table 1.Figure 1

Bottom Line:
Only one patient had recurrence after surgery, and another had lung metastasis when diagnosed with BcaFad.Adjuvant radiotherapy could be performed, but was not mandatory.Chemotherapy should be considered as a treatment option in the presence of lymph node metastasis.

Background: Breast cancer arising within a fibroadenoma (BcaFad) is rare; the rate varies from 0.002% to 0.125% in fibroadenoma specimens. Owing to its rarity, the clinicopathologic feature and treatment principle of BcaFad is still not clear. Therefore, the aim of this study was to perform a collective analysis of case reports in the literature to identify the characteristics and optimal treatment for BcaFad.

Methods: We analyzed an aggregated sample of 30 patients with BcaFad from case reports in the literature (n=24 cases) and our present study (n=6 cases). We collected and analyzed the clinicopathologic features and prognoses of patients with BcaFad, as well as treatments they received.

Results: The patients' mean age at diagnosis was 46.9 years. Twenty BcaFad patients (66.7%) received breast-conserving surgery (BCS), and nine other patients (30.0%) were treated with mastectomy. The rate of lymph node metastasis in BcaFad patients was 23.8%. The breakdown of the histological types of BcaFad was invasive ductal carcinoma (53.3%), followed by ductal carcinoma in situ (23.3%), lobular carcinoma in situ (16.7%) and invasive lobular carcinoma (13.3%). More than half of patients with positive hormone receptor status received hormone therapy. Most BcaFad patients with lymph node metastases received chemotherapy, and 20.0% of BcaFad patients treated with BCS received further radiotherapy. Only one patient had recurrence after surgery, and another had lung metastasis when diagnosed with BcaFad.

Conclusions: Most BcaFad patients could be managed by BCS. Adjuvant radiotherapy could be performed, but was not mandatory. Chemotherapy should be considered as a treatment option in the presence of lymph node metastasis.